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Cardio Oncology - Dr. Rakesh Gopal

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Cardio Oncology - Dr. Rakesh Gopal

Cancer therapy is associated with cardiac side effects. In fact most patients who survive a cancer dies of cardiovascular disease.

They need monitoring and treatment

12/12/2025

Hormonal therapy in breast cancer and cardiovascular risk

50 year old lady had carcinoma left breast , MRM done in 2016 , post chemotherapy with EC regime and Paclitaxel was on letrozole and monthly zoledronate .
She had hypothyroidism and Dyslipidemia on statin . Normotensive , euglycemic .
Patient defaulted on statin .
LDL shot up to 272mg / dl .
Patients with LDL cholesterol more than 190 mg /dl are at high risk of cardiovascular events and death .
Every patient on hormonal therapy should have good containment of coronary risk factors. Cardiovascular disease is the leading cause of death in cancer survivors

09/12/2025

Axitinib worsening hypertension .

A 55-year-old man with clear cell carcinoma of the kidney underwent radical right nephroureterectomy. He was started on immunotherapy with pembrolizumab and also Axitinib. He had impaired glucose tolerance, dyslipidemia, and hypertension. Within 8 weeks, his well-controlled hypertension worsened, with a blood pressure of 240/120 mmHg with severe headache. He required 10 mg bisoprolol, 10 mg amlodipine, 1.5 mg indapamide, and 5 mg prazosin for blood pressure control. His cancer-directed therapy was not changed since his response was good. Axitinib can cause severe hypertension. All patients should be warned and regular self monitoring of BP is advisable

04/12/2025

Olaparib is a targeted therapy approved for certain types of ovarian, breast, pancreatic, and prostate cancers, primarily in patients with BRCA gene mutations or other homologous recombination repair deficiencies.
Olaparib can cause acute myocardial infarction that can be fatal .
50 year old lady with carcinoma o***y was started on olaparib and Bevacizumab in 2023 , lost to follow up for one year there after when she opted non scientific therapies. Disease progressed . She returned for cancer directed therapy . She had multiple lines of chemotherapy followed by LAP Hysterectomy and BSO in November 2024 . Started on olaparib and Bevacizumab in July 2025. She is diabetic.
Had anterior wall MI cardiogenic shock following olaparib . Coronary angiography showed Left main and triple vessel disease . IABP was inserted . Three surgical teams rejected for CABG .
Her left main was stented into LAD , DEB to diagonal, stent to LCX, OM and RCA .
Had acute kidney injury, liver injury. IABP could be removed after 24 hours . She had Uneventful recovery from cardiac injury .
Patients planned for olaparib should be sufficiently warned and if they have risk factors properly addressed.

25/10/2025

50 year old lady was admitted on 21 st October 25 following multiple bone mets , unknown primary and paraplegia . Her baseline ECG and Echo was normal . She was being evaluated and a biopsy was planned . 24 hours later she had sudden death , medical emergency team could resuscitate her and rhythm was restored . ECG showed RBBB and ST depression in lateral leads . Triple inotropic support . Ventilated . A massive myocardial infarction with RBBB would mean extensive myocardial injury , severe LV dysfunction and a grave prognosis. See the echo below . RA RV dilatation , severe TR , severe PAH , RV dysfunction. LV is intact . We thrombolysed her without a CT PE protocol. Hemodynamics improved rapidly . Inotropes weaned off . ECG normalised next day . No RBBB . Echo showed good LV RV function. Normal sized RA and RV . No PAH . Do you agree with the management? Could have she been shifted for a CT Pulmonary angiogram or direct to Cathlab?

28/08/2025

Metastatic neuro endocrine tumor of prostate with nodal, liver and bone mets . Profound Bradycardia post Etoposide infusion. Asymptomatic. This ECG was taken 20 minutes after infusion . Rate had improved. Rare but known with Etoposide . Heart rate settled after three hours .
Due for cisplatin.

Mechanism of bradycardia involves deposition of drug in SA node , reactive oxygen species and direct myocyte injury . Drug can cause vasospasm and myocardial infarction . Atropine can be used to reverse bradycardia but since this patient was asymptomatic while flat on bed , nothing was required .

19/08/2025

Patient with ovarian cancer partial response to chemotherapy. Developed chest pain and cardiogenic shock . EF less than 20 percent. Left main and triple vessel disease . IABP . Refused by three surgical teams due to perceived non graftability of LAD . Two long stents over lapping from distal LAD until left main ostium , POT to LMCA to 5 mm . DEB to Diagonal . DEB to distal LAD . LCX stented . RCA collateralised total occlusion planned to attempt later . IABP removed and weaned off NIV next day . Echo after 2 weeks . Good LV function. LMCA stent seen in TTE . Due for chemotherapy. Mirvetuximab . Cancer should not stop you from treating CAD

15/08/2025

40 year old lady with carcinoma gall bladder . Metastatic disease . Pericardial effusion with tamponade , pericardiocentesis done . Noted LV dysfunction post tap . Treated . This echo is after chemotherapy. On day 8 . These lesions were not there during emergency admission for pericardiocentesis. What are they ?

11/07/2025

Lorlatinib induced Dyslipidemia

A 47-year-old lady with Non-Small Cell lung cancer, metastatic disease, was initially treated with ceritinib followed by Docetaxel. She was subsequently initiated on Lorlatinib. Hypertensive, on Bisoprolol. In 6 weeks, her total cholesterol shot up to 468 mg/dl, LDL 305.8, and triglyceride 451. Lorlatinib, an ALK inhibitor used to treat ALK-positive non-small cell lung cancer, can induce dyslipidemia in up to 80% of people treated. Increased intestinal lipid absorption and hepatic oversecretion of very-low-density lipoprotein particles may be the culprit.

Patient was started on 40 mg Rosuvastatin, 160 mg Bempedoic acid and Gemfibrozil 300 mg with advice to check lipid levels CPK SGOT SGPT after three months

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Chennai Hope Cardiology Center . Ispahani Centre . Nungambakkam High Road, Thousand Lights
Chennai
600006

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+919884741551

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